The present Invention is directed to an improved sterilization indicator, particularly one inserted into the sterilization chamber and based upon the interaction between DNA and dyes.
Both hospitals and doctors"" offices customarily require the presence of devices for sterilization of various medical instruments. These sterilizers are of two basic types, i.e. prevacuum and gravity. In the former case, air is evacuated from the sterilization chamber before the sterilization cycle is initiated. This assists the steam generated in penetrating both the sterilization indicator and the instruments being treated. The gravity cycle is similar to the prevacuum cycle except that no vacuum is applied. The former is almost universally used in hospitals and the latter in doctors"" offices and small clinics. Overall, approximately 25% of all sterilizers are of the gravity type, while the remaining are prevacuum. Since the gravity type is smaller and more compact, establishments such as individual doctors"" offices and small clinics tend toward their use. The prevacuum type is larger and cumbersome, and is capable of being operated as both a prevacuum sterilizer and a gravity sterilizer. Therefore, it is of importance that any sterilization indication method be suitable for both types of sterilizers.
The method of determining the effectiveness of the sterilization cycle includes placing the sterilization indicator in the sterilization chamber prior to beginning the sterilization cycle. The indicator contains a DNA preparation consisting of 0.25 to 1.0 xcexcg of initial DNA per xcexcl of water. A preferred concentration is 0.25 to 0.50 xcexcg of initial DNA per xcexcl. After the sterilization cycle has been completed, the cycled DNA is withdrawn from the sterilization chamber and placed on a support. Preferably, the support is a plastic having a negative surface potential, especially nylon or a nitrocellulose membrane. The latter two have a particular affinity for the DNA. The dye solution is placed on the cycled DNA and thereafter dipped into water and any change in color is observed.
The DNA has the ability to bind dyes within its structure, provided that the molecules are whole and complete. However, when the DNA is subjected to a combination of heat and steam (heat alone is insufficient), the structure breaks down so that the binding is less efficient. Thus, if sufficient heat and steam has contacted the DNA during the sterilization cycle, it will be fragmented and will not retain the dye. Therefore, when the membrane (for example) is dipped into the dye solution and then into water, a substantial and easily observable portion of the dye is dissolved. What remains on the paper looks substantially different from the original.
On the other hand, if the sterilization cycle is not complete, then the DNA molecule is substantially intact. As a result, the dye remains bound and very little will be washed off when it is dipped. Thus, the person carrying out the test can easily determine whether the cycle has done its job properly. Moreover, the results of the test are immediate; there is no need to wait for days or even hours to determine whether a given sterilization cycle has been suitably effective.
The DNA used is high molecular weight double stranded DNA. Obtaining the DNA from salmon sperm is the most economical way of providing this substance, but the source is not critical.
As to the dyes, ethidium bromide is the most tightly bound, followed by methylene blue. The former, however, is carcinogenic and should, therefore, be used only where suitable precautions will be taken. In particular, rubber gloves and similar protective means are suitable precautions to be taken in order to be sure that the dye does not contact the skin. In actual practice, methylene blue is more satisfactory since it is safe. Also, of particular interest are acridine orange and Vistra green, the latter being a product of Amersham Pharmacia Biotech.
The mechanism of binding is not certain. As to ethidium bromide and acridine orange, it is believed that they enter the DNA molecule and are intercalated between the nucleic acid pairs of hydrogen bonds located where the halves of the molecule meet. On the other hand, methylene blue does not intercalate and is less tightly bound to the DNA molecule. As a result, it is easier to wash out when dipped in water.
In some cases, it is desirable to determine the effectiveness of the indicator and this is done by the use of spores of particular microorganisms which are placed therein. Spores of Bacillus subtilis and Bacillus stearothermophilus, standard test organisms, are quite resistant to heat. At the end of the cycle, the spores of the microorganisms are cultured in the usual way to determine whether there is any growth. No growth indicates that they have been killed and that the sterilization cycle was effective. If the culture grows, then the opposite conclusion is reached. These results are compared with those obtained from the test pack in which the DNA is located, in order to determine that the indicator is operating properly.
In a desirable form of the Invention, the DNA is first subjected to the sterilization cycle. After withdrawal from the autoclave, it is deposited on the membrane (e.g. nitrocellulose or nylon), and a drop of dye solution is deposited thereon. Thereafter, it is dipped into water and observed. If the sterilization cycle is complete, the DNA will have been fragmented and/or the dye will not be bound thereto. Thus, when it is dipped into water, most (or all) of the dye will have been washed off. This is, of course, easily observable by the operator. It has been found particularly useful if some detergent is added to the wash water.
As a preferred form of the Invention, a further sample of the DNA is provided which is not introduced into the sterilization chamber. At the end of the cycle, this is dipped into the dye and then into the wash water and provides a standard for comparing the cycled DNA with the original. This aids in determining whether a change has occurred.
In the preferred form of the Invention, DNA in water solution is placed in a vial in the sterilizer. After the cycle is complete, the DNA is withdrawn from the sterilizer and dropped onto a suitable membrane such as nitrocellulose or nylon. This is followed by the application of the dye (e.g. methylene blue) on the DNA. At this point, the DNA is fully colored by the dye. It is then dipped into water and removed. If the sterilization cycle is complete, the DNA will have been fragmented and/or its ability to bind the dye will have been significantly reduced. As a result, most or all of the dye will wash off in the water and the membrane will evidence a substantial lightening of the color.
On the other hand, if the color does not lighten substantially, it indicates that the DNA remains substantially intact so that the dye remains bound to it. This indicates that the sterilization cycle is not complete and appropriate action must be taken. By including a small amount of the detergent in the water, the dye removal will be improved and the test will be more easily read.
The concentration of DNA in the DNA preparation should be 0.25 to 1.0 xcexcg/xcexcl as a practical and realistic range. Above the upper limit, there could be so much DNA present that, even with proper sterilization, there would be enough unbroken molecules to hold the dye so that the difference between the control (no breakdown) and the properly cycled DNA cannot be readily determined. On the other hand, if there is insufficient DNA (below the lower limit), then even an incomplete cycle will cause sufficient breakdown so that the remainder is insufficient to bind enough dye to maintain the color. Thus, outside the foregoing limits, the test becomes less reliable.